92-102139 ECEIVED BY „mit # Lna2 ' y 14 611
V LOPMENT DEPARTMENT
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C 0 2 'I992 CITY OF E`D WAY
BUILDING PERMIT APPLICATION
—Please Print-
BOX 1 TENANT NAME: S c_ , , 1 z - .-,
OWNER WM• S 2' a & CO. , INC. SITE LOCATION CAMPUS RIDGE -- LOT /,9
OWNER'S ADDRESS 2100-124th AVE. N.E. SUITE 100 CITY BELLEVUE PHONE 641-3939
DESCRIBE JOB CONSTRUCTION OF SINGLE FAMILY HOUSE
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION X
BOX 2 CONTRACTOR'S NAME WM. SHERMAN & CO. , INC. CONTRACTOR'S REG. #WMSHECI174L4
Card MUST be presented
CONTRACTOR'S ADDRESS 2100-124TH AVE. N.E. CITY BELLEVUE PHONE 641-3939
EXPIRATION DATE JULY, 1993
— OR —
I HAVE READ CHAPTER 18.27.010 RELATING TO DEFINITIONS OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION.
BOX 3 CONTACT PERSON JOHN ELLINGWOOD PHONE 641-3939
BOX 4 SEWER DISTRICT FEDERAL WAY WATER & SEWER WATER DISTRICT FEDERAL WAY WATER & SEWER
BOX 5 ESTIMATED PROJECT COST / d/ ,a, EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER 462/l'-' '// C-' - ' 3
LEGAL DESCRIPTION . /Ta�l� ,E' d .,• Z'-.cl
0 '1u sion
(If necessary, please submit
separate oage with the legal description.)--.. 21��� ��� S�
K.C. Plat Recording # 9111221774 0/111-
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR_____./ /3- 6-2 2ND FLOOR / /-?.?
3RD FLOOR / BASEMENT / DECK / GARAGE / F7 '
BOX 8 (X) SINGLE FAMILY (X ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = ) ( ) EXISTING STRUCTURE
( ) COMMERCIAUINDUSTRIAL TOTAL AREA OF PROPERTY 61-A-) 77 SQ FT
BOX 9 PLUMBING FIXTURES (including rough-ins) MECHANICAL APPLIANCES — BASIC FEE$
NO. ,-J WATERCLOSETS GAS PIPING, FEET $
• BATHTUBS NO. / FURNACE, ELEC. GAS X, $
SHOWERS / GAS HOT WATER HEATER $
6 LAVATORIES C CONVERSION BURNER $
SINKS C BOILER, SIZE BTU $
/ DISHWASHERS C AIR HANDLING UNITS $
G% ELECTRIC HOT WATER HEATER C HEAT PUMPS, SIZE $ —
/ LAUNDRY WASHER OUTLET C UNIT HEATERS $
C URINALS C AIR COOLING UNITS, SIZE $
C DRINKING FOUNTAINS 2 COMMERCIAL HOOD $
O SUMPS, SPRINKLER VACUUM BREAKERS -'' OTHER $
C' DRAINS $
• OTHER $
TOTAL FIXTURES $
TOTAL MECHANICAL FEE $
I CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE
AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE ABOVE PREMISES TO PERFORM THE WORK FOR WHICH PERMIT APPLICATION IS
MADE.I FURTHER AGREE TO SAVE HARMLESS THE CITY OF FEDERAL WAY AS TO ANY CLAIM(INCLUDING COSTS,EXPENSES,AND ATTORNEYS'
FEES INCURRED IN INVESTIGATION AND DEFENSE OF SUCH CLAIM), WHICH MAY BE MADE BY ANY PERSON, INCLUDING THE UNDERSIGNED,
AND FILED AGAINST THE CIS OF FEDERAL WAY, ' T ONLY W4.1,RE SUCH CLAIM ARISES OUT OF TH RELIANCE OF THE CITY,INCLUDING ITS
OFFICERS AND EMPLOYE•t., PON THE ACCU')rY OFT , ORMATION SUPPLIED TOT{7 ''SAS A PA OF THIS PLI TION.
OWNER/AGENT: .A, i . J i(d //L DATE: /7 .
/ ANP•008 3,90
SIVE PL APPROVAL
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OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE) RECEIVED BY
ZONE SETBACKS: FRONT SIDE REAR HEIGHT LIMItuNTTY DEVELOPMENT DEPARTMENT
PLANNING DEPARTMENT APPROVAL UECZ 1992
REMARKS:
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL DATE
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL DATE
REMARKS:
TYPE OF JOB: NEW RESIDENCE RES. ADD/ALT NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL COMM. ADD/ALT NEW MULTIFAMILY (UNITS )
MULTIFAMILY ADD/ALT TENANT IMP. OTHER
OCCUPANCY TYPE OF CONSTRUCTION STORES
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
TOTAL SQ. FT. TOTAL VALUATION
BUILDING DEPARTMENT REMARKS: PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE
MECHANICAL FEE
TOTAL BLDG. FEES
PART P/C FEE
SEPA REVIEW
S.B.C.C. FEE
OTHER FEES
AMOUNT DUE
ASSIGNED ADDRESS:
PARTIAL PLAN CHECK FEE RECEIVED
Amount Date Receipt#
BUILDING DEPARTMENT APPROVAL
RECEIVED BY DATE ACCEPTED FOR FILING